Obesity, the new disease

Declaring obesity a disease will not end Americans’ struggles with weight gain. But the American Medical Association’s recent decision to do so has already drawn new attention to this important health...

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Posted Jul. 1, 2013 @ 12:01 am

Declaring obesity a disease will not end Americans’ struggles with weight gain. But the American Medical Association’s recent decision to do so has already drawn new attention to this important health issue.

Since the 1960s, when scarcely a quarter of U.S. adults were deemed overweight or obese, Americans have been packing on the pounds. By the 1980s, the proportion of overweight adults had risen to a third of the total, and by 1990, to more than half. In particular, the heaviest Americans became more numerous: in 2008, according to the Centers for Disease Control and Prevention, 35.7 percent of U.S. adults qualified as obese.

It turns out, though, that “obese” is hard to define. Usually, a measure called body-mass index (BMI) is used. BMI combines height and weight in a number that roughly indicates body fat, but the number can be misleading. In fact, for that reason, a special AMA study committee concluded that obesity should not be defined as a disease. However, a broader membership vote overrode its recommendation.

Determining the cause of obesity has been even more difficult than defining it. Plenty of culprits have been fingered, including Americans’ sedentary lifestyle, sugary beverages and other processed foods, increased portion sizes, and genetics. Research thus far suggests that all these things play a role, but definitive answers remain elusive.

The AMA’s classification of obesity as a disease is not legally binding. But, helpfully, it could spur insurers to cover more weight-loss treatment. (The Internal Revenue Service code has allowed deductions for weight-loss programs for roughly a decade.) It could also encourage new genetic research and work on weight-loss drugs.

Even those who deny that obesity is a disease concede that it leads to recognized illnesses, with heart disease and Type 2 diabetes high on the list. Associated medical costs have been set by the CDC at around $147 billion a year.

The AMA’s pronouncement will be most helpful if it erases some of the stigma of being overweight, and encourages people to take action. But it could prove a setback if it leads to one-size-fits-all solutions. Very often, the best answer is a healthier diet and more exercise, not medical treatments such as costly surgery or drugs with harmful side-effects.

Meanwhile, despite greater public awareness, little progress toward a slimmer nation has been made. We need to understand far more than we do about why so many have gained so much.